title: Use of phosphate-binding agents is associated with a lower risk of mortality.
abstract: Hyperphosphatemia has been associated with higher mortality risk in CKD 5 patients receiving dialysis. Here, we determined the association between the use of single and combined phosphate-binding agents and survival in 6797 patients of the COSMOS study: a 3-year follow-up, multicenter, open-cohort, observational prospective study carried out in 227 dialysis centers from 20 European countries. Patient phosphate-binding agent prescriptions (time-varying) and the case-mix-adjusted facility percentage of phosphate-binding agent prescriptions (instrumental variable) were used as predictors of the relative all-cause and cardiovascular mortality using Cox proportional hazard regression models. Three different multivariate models that included up to 24 variables were used for adjustments. After multivariate analysis, patients prescribed phosphate-binding agents showed a 29 and 22% lower all-cause and cardiovascular mortality risk, respectively. The survival advantage of phosphate-binding agent prescription remained statistically significant after propensity score matching analysis. A decrease of 8% in the relative risk of mortality was found for every 10% increase in the case-mix-adjusted facility prescription of phosphate-binding agents. All single and combined therapies with phosphate-binding agents, except aluminum salts, showed a beneficial association with survival. The findings made in the present association study need to be confirmed by randomized controlled trials to prove the observed beneficial effect of phosphate-binding agents on mortality.
authors.affiliation: Bone and Mineral Research Unit, Instituto Reina Sofía de Investigación, REDinREN del ISCIII, Hospital Universitario Central de Asturias, Universidad de Oviedo, Oviedo, Spain.
authors.forename: Jorge B
authors.initials: JB
authors.lastname: Cannata-Andía
authors.forename: José L
authors.initials: JL
authors.lastname: Fernández-Martín
authors.forename: Francesco
authors.initials: F
authors.lastname: Locatelli
authors.forename: Gérard
authors.initials: G
authors.lastname: London
authors.forename: José L
authors.initials: JL
authors.lastname: Gorriz
authors.forename: Jürgen
authors.initials: J
authors.lastname: Floege
authors.forename: Markus
authors.initials: M
authors.lastname: Ketteler
authors.forename: Aníbal
authors.initials: A
authors.lastname: Ferreira
authors.forename: Adrian
authors.initials: A
authors.lastname: Covic
authors.forename: Boleslaw
authors.initials: B
authors.lastname: Rutkowski
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Memmos
authors.forename: Willem-Jan
authors.initials: WJ
authors.lastname: Bos
authors.forename: Vladimir
authors.initials: V
authors.lastname: Teplan
authors.forename: Judit
authors.initials: J
authors.lastname: Nagy
authors.forename: Christian
authors.initials: C
authors.lastname: Tielemans
authors.forename: Dierik
authors.initials: D
authors.lastname: Verbeelen
authors.forename: David
authors.initials: D
authors.lastname: Goldsmith
authors.forename: Reinhard
authors.initials: R
authors.lastname: Kramar
authors.forename: Pierre-Yves
authors.initials: PY
authors.lastname: Martin
authors.forename: Rudolf P
authors.initials: RP
authors.lastname: Wüthrich
authors.forename: Drasko
authors.initials: D
authors.lastname: Pavlovic
authors.forename: Miha
authors.initials: M
authors.lastname: Benedik
authors.forename: José Emilio
authors.initials: JE
authors.lastname: Sánchez
authors.forename: Pablo
authors.initials: P
authors.lastname: Martínez-Camblor
authors.forename: Manuel
authors.initials: M
authors.lastname: Naves-Díaz
authors.forename: Juan J
authors.initials: JJ
authors.lastname: Carrero
authors.forename: Carmine
authors.initials: C
authors.lastname: Zoccali
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000401:mortality / Q000517:prevention & control*; D002614:Chelating Agents / Q000627:therapeutic use*; D016009:Chi-Square Distribution; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D054559:Hyperphosphatemia / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010710:Phosphates / Q000097:blood*; D057216:Propensity Score; D016016:Proportional Hazards Models; D011446:Prospective Studies; D006435:Renal Dialysis / Q000009:adverse effects / Q000401:mortality; D051436:Renal Insufficiency, Chronic / Q000097:blood / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D002614:Chelating Agents; D010710:Phosphates